A predictive marker for target organ damage in primary hypertension: serum uric acid levels
Keywords:Primary hypertension, hyperuricemia, carotid intima media thickness, left ventricular mass index
Background: This study aims to investigate the relationship between serum uric acid levels, the left ventricular mass index (LVMI), and carotid intima media thickness (CIMT) in primary hypertension patients.
Material and Method: A total of 139 primary hypertension patients, including 45 (32.4%) men and 94 (67.6%) women were involved in the study. The laboratory and clinical demographic findings, as well as the LVMI and CIMT levels of the patients were collected from patient files.
Results: 37% of the study population were found to have hyperuricemia. LVMI (99.75±13.4 vs 86.17±17.6; p=0.010) and CIMT (0.88±0.26 vs 0.75±0.17; p=0.023) levels were found to be higher in the hyperuricemia versus the non-hyperuricemia group. According to the correlation analysis, there was a positive correlation between uric acid and LVMI (r=0.282, p=0.032) and CIMT (r=0.285, p=0.002) levels. Robust regression analysis showed that uric acid was an independent risk factor for both the LVMI (β±SE: 1.615±1.03, p<0.05) and CIMT (β±SE: 0.251±0.09, p<0.05).
Conclusion: We found serum uric acid levels to be closely related with the target organ damage associated with primary hypertension, and even related with target organ damage independent from blood pressure.
WHO. The World Health Report 2001: Mental health: new understanding, new hope. 2001: World Health Organization.
Schiffrin EL, Campbel N, Feldman R, et al. Hypertension in Canada: past, present, and future. Ann Glob Health 2016; 82: 288-99.
Cunningham KS, Gotlieb AI. The role of shear stress in the pathogenesis of atherosclerosis. Lab Invest 2005; 85: 9.
Priestley JR, Matthew WB, McEwen ST, et al. Reduced angiotensin II levels cause generalized vascular dysfunction via oxidant stress in hamster cheek pouch arterioles. Microvasc Res 2013; 89: 134-5.
Ates, I, Ozkaya N, Ateş H, et al. Elevated circulating sST2 associated with subclinical atherosclerosis in newly diagnosed primary hypertension. Hypertens Res 2016; 39: 513-8.
Mancia G, Fagar R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013; 34: 2159-219.
Champe P, Harvey R. Nucleotid Metabolism In: Biochemistry. 1994, Lippincott’s Illustrated Reviews, Lippincott Company.
Hink HU, Santanam N, Dikalov S, et al. Peroxidase properties of extracellular superoxide dismutase: role of uric acid in modulating in vivo activity. Arterioscler Thromb Vasc Biol 2002; 22: 1402-8.
Mazzali M, Kanellis J, Han L, et al. Hyperuricemia induces a primary renal arteriolopathy in rats by a blood pressure-independent mechanism. Am J Physiol Renal Physiol 2002; 282: 991-7.
Feig DI, Kang DH, Johnson RJ. Uric acid and cardiovascular risk. New England J Med 2008; 359: 1811-21.
Fang J, Alderman MH. Serum uric acid and cardiovascular mortality: the NHANES I epidemiologic follow-up study, 1971-1992. JAMA 2000; 283: 2404-10.
Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972; 18: 499-502.
Levey AS, Stevens LA, Schid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009;150: 604-12.
O’Brien E, Atkins N, Stergiou G, et al. European Society of Hypertension International Protocol revision 2010 for the validation of blood pressure measuring devices in adults. Blood Press Monit 2010; 15: 23-38.
Alderman MH, Cohen H, Madhavan S, Kivlighn S. Serum uric acid and cardiovascular events in successfully treated hypertensive patients. Hypertension 1999; 34: 144-50.
Verdecchia P, Schillaci G, Santeusanio F, Porcelatti C, Brunetti P. Relation between serum uric acid and risk of cardiovascular disease in essential hypertension. Hypertension 2000; 36: 1072-8.
Zhang J, Zhang Y, Deng W, Chen B. Elevated serum uric acid is associated with angiotensinogen in obese patients with untreated hypertension. J Clin Hypertens 2014; 16: 569-74.
Viazzi F, Parodi D, Leoncini G, et al. Serum uric acid and target organ damage in primary hypertension. Hypertension 2005; 45: 991-6.
Langlois M, Bacquer DD, Duprez D, Buyzere MD, Delanghe J, Blaton V. Serum uric acid in hypertensive patients with and without peripheral arterial disease. Atherosclerosis 2003; 168: 163-8
Bae JS, Shin DS, Park PS, et al. The impact of serum uric acid level on arterial stiffness and carotid atherosclerosis: the Korean Multi-Rural Communities Cohort study. Atherosclerosis 2013; 231: 145-51.
Tavil Y, Kaya MG, Oktar SO, et al. Uric acid level and its association with carotid intima–media thickness in patients with hypertension. Atherosclerosis 2008; 197: 159-63.
Neogi T, Ellison RC, Hunt S, et al. Serum uric acid is associated with carotid plaques: the National Heart, Lung, and Blood Institute Family Heart Study. J Rheumatol 2009; 36: 378-84.
Liese AD, Hense HW, Löwel H, Döring A, Tietze M, Keil U. Association of serum uric acid with all-cause and cardiovascular disease mortality and incident myocardial infarction in the MONICA Augsburg cohort. Epidemiology 1999: 391-7.
Lehto S, Niskanen L, Rönnemaa T, Laakso M. Serum uric acid is a strong predictor of stroke in patients with non–insulin-dependent diabetes mellitus. Stroke 1998; 29: 635-9.
Rafieian-Kopaei M, Behradmanesh S, Kheiri S, Nasri H. Association of serum uric acid with level of blood pressure in type 2 diabetic patients. Iran J Kidney Dis 2014; 8: 152-4.
Fukui, M, Tanaka M, Shiraishi E et al. Serum uric acid is associated with microalbuminuria and subclinical atherosclerosis in men with type 2 diabetes mellitus. Metabolism 2008; 57: 625-9.
Weir CJ, Muir SW, Walters MR, Lees KR. Serum urate as an independent predictor of poor outcome and future vascular events after acute stroke. Stroke 2003; 34: 1951-6.
Chamorro A, Obach V, Cervera A, Revilla M, Deulofeu R, Aponte JH. Prognostic significance of uric acid serum concentration in patients with acute ischemic stroke. Stroke 2002; 33: 1048-52.
Romanos E, Planas AM, Amaro S, Chamorro A. Uric acid reduces brain damage and improves the benefits of rt-PA in a rat model of thromboembolic stroke. J Cereb Blood Flow Metab 2007; 27: 14-20.
Khosla UM, Zharikov S, Finch JL, et al. Hyperuricemia induces endothelial dysfunction. Kidney Int 2005; 67: 1739-42.
Bagnati M, Perugini C, Cau C, Bordone R, Albano E, Bellomo G. When and why a water-soluble antioxidant becomes pro-oxidant during copper-induced low-density lipoprotein oxidation: a study using uric acid. Biochem J 1999; 340: 143-52.
Hotamisligil GS. Inflammation and metabolic disorders. Nature 2006; 444: 860.
De Luca G, Secco GG, Santagostino M, et al. Uric acid does not affect the prevalence and extent of coronary artery disease. Results from a prospective study. Nutr Metab Cardiovasc Dis 2012; 22: 426-33.
Cicero AF, Salvi P, D’Addato S, Rosticci M, Borghi C. Association between serum uric acid, hypertension, vascular stiffness and subclinical atherosclerosis: data from the Brisighella Heart Study. J Hypertens 2014; 32: 57-64.
Johnson RJ, Kang DH, Feig D, et al. Is there a pathogenetic role for uric acid in hypertension and cardiovascular and renal disease? Hypertension 2003; 41: 1183-90.
Krishnan E, Kwoh CK, Schumacher HR, Kuller L. Hyperuricemia and incidence of hypertension among men without metabolic syndrome. Hypertension 2007; 49: 298-303.
Mellen PB, Bleyer AJ, Erlinger TP. Serum uric acid predicts incident hypertension in a biethnic cohort. Hypertension 2006; 48: 1037-42.
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.